The dilated ventricle displayed continuous evolution of the vortex ring throughout diastole. In controls, the vortex ring boundary was in close proximity to the endocardium after the initial growth phase. (b) Distance between vortex ring surface (LCS) and endocardium of the left ventricle (mean ± SD). In the patient, however, the vortex ring continued to grow independently of LV volume, leading to additional entrainment of ventricular blood. Vortex ring development was initially similar between patients and controls. Measurements of vortex ring parameters.: (a) Volume-time curves of one control and one patient. LV, left ventricle RV, right ventricle LA, left atrium Ao, aorta *, vortex core. In the patients, vortex ring formation occurred without an obvious connection to the endocardium, and the vortex ring moved along the inferior LV wall towards the apex. After the formative phase, the vortex ring evolved close to the endocardial border (red dotted line) in the control, gaining additional complexity compared to the water tank model. Healthy control (top), patient with ischemic cardiomyopathy (middle), and non-ischemic dilated cardiomyopathy (bottom). (c) LCS showing vortex ring formation during filling of the LV. As water is injected from a nozzle into a tank, a symmetrical vortex ring forms (left), detaches and evolves (middle), then gradually breaks down into more complex flow patterns (right). (b) Water tank experiment with LCS analysis of vortex rings. Image modified from an original by NASA Earth Observatory, with permission42. The LCS persists for several kilometers and grows increasingly uneven and complex as eddies contribute to mixing of the two flows. The border separating flows of different origins (colored line) is, by definition, a Lagrangian Coherent Structure (LCS). Characteristics of vortex-wall interaction provide unique physiologic and mechanistic information about cardiac diastolic function that may be applied to guide the design and implantation of prosthetic valves, and have potential clinical utility as therapeutic targets for tailored medicine or measures of cardiac health.įlow patterns by Lagrangian Coherent Structures.: (a) The black water of the Rio Negro meets the muddy water of the Rio Solimoẽs outside Manaus, Brazil. Vortex ring volume was unrelated to early rapid filling (E-wave) velocity in patients and controls. Healthy hearts demonstrate a strong coupling between vortex and cardiac volumes (R2 = 0.83), but this optimized phenotype is lost in heart failure, suggesting restoration of normal vortex ring dynamics as a new, and possibly important consideration for individualized heart failure treatment. Using novel and validated magnetic resonance imaging measurements, we show that the healthy left ventricle moves in tandem with the expanding vortex ring, indicating that cardiac form and function is epigenetically optimized to accommodate vortex ring formation for volume pumping. The laws of fluid dynamics govern vortex ring formation and precede cardiac development by billions of years, suggesting that diastolic vortex ring formation is instrumental in defining the shape of the heart.
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